Healthcare Provider Details

I. General information

NPI: 1760433908
Provider Name (Legal Business Name): AKINOLA O OGUNDIPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 VIRGINIA AVE
PONCA CITY OK
74601-2911
US

IV. Provider business mailing address

609 VIRGINIA AVE
PONCA CITY OK
74601-2911
US

V. Phone/Fax

Practice location:
  • Phone: 580-767-1300
  • Fax: 580-765-4529
Mailing address:
  • Phone: 580-767-1300
  • Fax: 580-765-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number04-24516
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18134
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number18134
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number04-24516
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number04-24516
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number18134
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: